The Clinical Significance of Abnormal Urological Uptake of Tc-99m MDP in Cervical Cancer Patients

子宮頸癌患者泌尿系統鎝-99mMDP異常攝取之臨床意義

黃文盛(Wen-Sheng Hwang)；周耀宗(You-Chung Chou)；何濤(Tom Ho)；李永康(Ju-Kong Lee)；陳維廉(Wei-Lian Chen)；李超群(Chau-Chin Li)

鎝-99m MDP骨骼閃爍攝影 ； 骨閃爍攝影圖 ； 放射活性 ； 放射製劑 ； Tc-99m MDP Bone scintigraphy ； Bone scintigram ； Radioactivity ； Radiopharmaceutical

Journal of Medical Sciences

6卷2期（1985 / 11 / 01）

185 - 193

英文

對易致骨轉移之癌症如子宮頸癌，骨骼閃爍攝影檢查已成為臨床之重要篩驗工具，而Tc-99m MDP（Technetiurn-99m methylene diphosphonate）是目前最常接用作此項檢查之放射性製劑，此一製劑經靜脈注射後，除被骨骼攝取外；其餘多經腎臟排出。其排出量，依據不同文獻報告，在注射後3小時佔初劑量之1/3至1/2。因此；利用此一特性，我們可在患者接受骨骼攝影之同時，配合新型掃瞄儀之使用，看到清晰之腎臟影像和液體在泌尿系統中之動力變化。泌尿與生殖系統在胚胎學上同出一源，其解剖位置又極為接近；有文獻報告，生殖系統異常最後常併發泌尿系統之紊亂。子宮頸癌之於阻塞性泌尿道病變即為一例，然而此種現象，在早期多無症狀。在過去數年間，吾人常可在子宮頸癌患者接受骨骼攝影之同時，意外發現異常之泌尿道影像，此種現象是否具有臨床意義，為本文所要探討之重點。本部自民國73年2月至74年1月，共搜集43位病例，包括20例泌尿道造影正常和23位接受骨骼攝影同時出現泌尿道活性異常之子宮頸癌患者。利用骨骼閃爍攝影，結果發現，對泌尿道活性異常之疾病診斷，其靈敏度為85.0%，專一性為73.9%，腎盂積水和／或輸尿管積水是造成此類異常最常見之原因。故得結論為，子宮頸癌患者接受骨骼攝影時，其所呈現之泌尿道異常活性變化，頗具臨床意義；不但可評估患者骨骼本身之病變，亦對可能導致患者不可逆變化却又無明顯症狀之泌尿道異常作早期偵測，而達到早期預防或治療之目的。

Tc-99m MDP (technetium-99m methylene diphosphonate) is currently recognized as the most common radiopharmaceutical tool in detecting skeletal metastasis of cervical carcinoma. In ordinary condition certain amount of the tracer post i.v. injection is excreted through the urinary system. Thus, the kidneys can also be seen clearly while the cervical cancinoma patient receives bone scintigraphy. Recently, literatures indicated that the urinary system could be the most favorable area for cervical cancer involvement although it was asymptomatic. Therefore, the purpose of this study was to determine the efficacy of Tc-99m MDP in detecting undermine renal abnormalities while doing bony scintigraphy on cervical cancer patients. From Feburary 1984 to January 1985, patients who had a renal radiographic examine within fifteen days were selected for this study. 23 cases who met this criterion were selected, in addition to 20 cases served as the control group who had normal renal image. According to the analysis of urinary involvement, the sensitivity was about 85.0% the specificity was 73.9%. lt was also revealed that, in addition to detecting skeletal abnormality, the bone scintigraphy could also provide some useful data of renal function and a significant correlation to the incidence of renal abnormalities.